Marian (Emmy) Betz MD, MPH

Title: Principal Investigator; Director, Firearm Injury Prevention Initiative, Patient Centered Injury Prevention, Associate Professor, Emergency Medicine

Contact: marian.betz@cuanschutz.edu

University of Colorado webpage

Elected to the National Academy of Medicine (NAM). Election to the Academy is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service.

2023 Top Doc for Emergency Medicine from 5280 Magazine

She is currently a Professor of Emergency Medicine (University of Colorado School of Medicine), Deputy Director of the Injury and Violence Prevention Center (Colorado School of Public Health), and a Research Physician at the Geriatric Research, Education and Clinical Core (Eastern Colorado VA). She founded and leads the CU Anschutz Firearm Injury Prevention Initiative, and she co-founded and leads the Colorado Firearm Safety Coalition, a collaborative effort between public health and medical professionals and firearm retailers to reduce firearm suicides.

Research Interest

Dr. Betz’s area of research expertise is “patient-centered injury prevention,” or the development and testing of acceptable, effective interventions for clinical settings. Her current areas of work include “lethal means safety” (i.e., reducing access to guns and other lethal methods for those with suicide risk), older driver retirement, and firearm safety in dementia. She is a recognized national expert in firearm injury prevention and has been invited to work with numerous organizations, spanning medical specialties and the civilian to veteran spectrum. Examples include medical organizations (the American College of Emergency Physicians, the American College of Surgeons), the American Bar Association, multiple VA workgroups, the Department of Defense Suicide Prevention Office, and White House events or initiatives under the Obama, Trump and Biden administrations. She serves as PI and Co-I on multiple research projects funded through the National Institutes of Health, Department of Defense, and private foundations.

Grants & Funding

Office of Gun Violence Prevention Resource Bank Implementation

This project supports the Colorado Office of Gun Violence Prevention in fulfilling the expectations laid out in Colorado House Bill 21-1299, including the development and maintenance of a resource bank as a repository for data, research, and statistical information regarding firearm injuries and deaths, and their prevention, in Colorado. 
Funder: Colorado Department of Public Health & Environment

Project Safe Guard: Evaluation of Training

This project aims to evaluate the training of National Guard key personnel for delivery of Project Safe Guard to Guardsmen.
Funder: U.S. Department of Defense/Henry M. Jackson Foundation

Protective Environments: Military Community Engagement to Prevent Firearm-Related Violence

Project Safe Guard (PSG) is a universal brief intervention that increased secure storage of home firearms in a research study in the Mississippi National Guard. Our team, including the investigators who developed PSG, proposes to adapt and test PSG in a ‘real world’ sample of active duty Airmen at Buckley Air Force Base and Buckley Garrison (host).
Our overarching objective is to facilitate the implementation of acceptable, effective interventions for the prevention of suicide and other non-fatal and fatal violence in military populations, with a focus on voluntary reductions in firearm access during at-risk periods as a way to decrease the risk of death. In this three-year project, we aim to use community engagement to adapt PSG and test it in a hybrid effectiveness-implementation trial.
Funder: U.S. Department of Defense/Medical Technology Enterprise Consortium

Protective Environments: Military Community Engagement to Prevent Firearm Suicide

This study aims explore firearm locking device use and preferences among firearm-owning adults and military spouse and family perspectives on firearm storage in the home and lethal means safety messaging for service members.
Funder: U.S. Department of Defense/Defense Health Agency

SECuRe - Securing the Environment, Connecting to Reduce Risk

The SECuRe study aims to adapt and pilot the Lock to Live (L2L) firearm and medication storage decision-making tool for use within the Military Health System. 
Funder: U.S. Department of Defense/Defense Health Agency
Publications of note:
— "Lock to Live" for firearm and medication safety: Feasibility and acceptability of a suicide prevention tool in a learning healthcare system

Decision Making Among Older Adults: the AUTO study

Deciding when to “hang up the car keys” is one of the most emotional and difficult decisions older adults face, especially in the context of age-associated cognitive impairment, such as Alzheimer’s disease. Yet, it is also one that almost every individual, and their family, must wrestle with. 
A web-based decision aid could help older adults make informed decisions about driving that align with personal values. Understanding which types of older adults benefit most from the decision aid, along with when to use the decision aid, will help optimize real-world use.
Such a decision aid may be necessary for individuals with cognitive impairment, such as that associated with Alzheimer’s disease, particularly in its earliest stages. The condition may complicate driving decisions and increase driving risk and the need for eventual driving cessation.
Funder: National Institute on Aging
NIH website
Publications of note:
— "Is it time to stop driving?": A randomized clinical trial of an online decision aid for older drivers
— Cars, Guns, Aging, and “Giving Up the Keys”
— The Advancing Understanding of Transportation Options (AUTO) study: design and methods of a multi-center study of decision aid for older drivers

"Safety in Dementia": An Online Caregiver Intervention

Deciding when and how to reduce firearm access for a person with Alzheimer's Disease and related dementias (ADRD) is one of the most emotional and complex issues informal caregivers face. Yet it is one that many caregivers must address, given the prevalence of firearms in the homes of community-dwelling people with ADRD. 
The online "Safety in Dementia" decision aid provides caregivers with respectful, practical assistance in working through the decision, helping them reduce firearm access and prevent unintentional or intentional injuries. 
Through this multi-disciplinary proposal, we will test "Safety in Dementia" in an online, nationwide trial with a diverse sample of caregivers, thereby improving our understanding of both the decision aid's effects and how to use various methods to reach and engage caregivers.
Funder: National Institute on Aging
NIH website

Decision Making Among Older Adults: "Firearm Retirement"

Deciding when it's time for "driving retirement" is one of the most emotional and difficult decisions older adults face – yet it is also one that almost every individual, and their family, must wrestle with. Our team is exploring it through an active R01 study. 
Firearm access can also pose injury risks for older adults with declining physical or cognitive abilities. Still, we know little about how older adults make decisions about "firearm retirement." 
Through this proposal, we will improve our understanding of stakeholder views about firearm retirement in general and particular contexts (likely onset of dementia or other significant illness or loss) to inform our development of prototypes of culturally competent guidelines and resources for intervention.
Funder: National Institute on Aging
NIH website
Publications of note:
— Cars, Guns, Aging, and “Giving Up the Keys”
— Older adults and planning for firearm safety: A qualitative study of healthcare providers

Recent Publications

2024

Haasz M, Johnson RL, Simonetti JA, Betz ME, Cafferty R, Brooks-Russell A, Wright-Kelly E. Perceptions of Firearm Safety and Youth Suicide Among Adults With a Child in Their Home. Pediatrics. 2024 Sep 27:e2024066930. doi: 10.1542/peds.2024-066930. Epub ahead of print. PMID: 39327955.

Zeoli AM, Molocznik A, Paruk J, Omaki E, Frattaroli S, Betz ME, Christy A, Kapoor R, Knoepke C, Ma W, Norko MA, Pear VA, Rowhani-Rahbar A, Schleimer JP, Swanson JW, Wintemute GJ. A multi-state evaluation of extreme risk protection orders: a research protocol. Inj Epidemiol. 2024 Sep 9;11(1):49. doi: 10.1186/s40621-024-00535-z. PMID: 39252094; PMCID: PMC11382528.

Waddle SD, Thomas A, Campbell BT, Betz ME, Johnson JK, Royan R, Ellyin A, Jang A, Crandall ML, Stey AM. Exploratory qualitative study of firearm storage practices among surgeons in the USA: contexts and motivations. Inj Prev. 2024 Aug 29:ip-2023-045205. doi: 10.1136/ip-2023-045205. Epub ahead of print. PMID: 39209735.

Walsh A, Friedman K, Morrissey BH, Godin S, Morgenstein J, Bryan CJ, Anestis MD, Foley SK, Johnson RL, Baker JC, Bryan A, Betz ME, Wright-Kelly E. Project Safe Guard: Evaluating a Lethal Means Safety Intervention to Reduce Firearm Suicide in the National Guard. Mil Med. 2024 Aug 19;189(Supplement_3):510-516. doi: 10.1093/milmed/usae172. PMID: 39160836.

Haasz M, Betz ME, Ambroggio L, Cafferty R, King CA, Wong S, Leonard J, Brooks-Russell A, Sigel E. Acceptability and feasibility of video-based firearm safety education in a Colorado emergency department for caregivers of adolescents in firearm-owning households. Inj Prev. 2024 Jul 24:ip-2023-045204. doi: 10.1136/ip-2023-045204. Epub ahead of print. PMID: 39053924.

Wright-Kelly E, Buck-Atkinson JT, Betz ME, Little K, Little JS, Kingston BE, Sigel E, Arredondo-Mattson S. Firearm businesses as partners in suicide prevention: a cross-sectional study of the Gun Shop Project in Colorado, USA. Inj Prev. 2024 Jul 15:ip-2023-045178. doi: 10.1136/ip-2023-045178. Epub ahead of print. Haasz M, Betz ME, Ambroggio L, Cafferty R, King CA, Wong S, Leonard J, Brooks-Russell A, Sigel E. Acceptability and feasibility of video-based firearm safety education in a Colorado emergency department for caregivers of adolescents in firearm-owning households. Inj Prev. 2024 Jul 24:ip-2023-045204. doi: 10.1136/ip-2023-045204. Epub ahead of print. PMID: 39009435.

Barnard LM, Batta N, McCarthy M, Thies K, Robinson C, Schultze M, Betz ME, Knoepke CE. Implementation of Extreme Risk Protection Orders in Colorado from 2020 to 2022: Firearm relinquishment and return and petitioner characteristics. Prev Med Rep. 2024 Jun 20;44:102800. doi: 10.1016/j.pmedr.2024.102800. PMID: 39035359; PMCID: PMC11260331.

Richards JA, Kuo E, Stewart C, Shulman L, Parrish R, Whiteside U, Boggs JM, Simon GE, Rowhani-Rahbar A, Betz ME. Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based "Lock to Live" Decision Aid in Routine Health Care Encounters. JMIR Med Inform. 2024 Apr 22;12:e48007. doi: 10.2196/48007. PMID: 38647319; PMCID: PMC11063417.

Simonetti JA, Holliday R, Mignogna J, Thomas S, Smith A, Betz M, Brenner LA, Sayre G. Patients' Perspectives on Medication-Related Suicide Prevention Interventions Delivered in Emergency Settings. Psychiatr Serv. 2024 Mar 1;75(3):275-282. doi: 10.1176/appi.ps.20230178. Epub 2023 Nov 7. PMID: 37933134.

Bowen DM, Rowhani-Rahbar A, McCourt A, Betz M, Rivara FP. Variations in State Laws on Mental Health-Related Firearm Prohibition. JAMA Intern Med. 2023 Dec 1;183(12):1402-1404. doi: 10.1001/jamainternmed.2023.5092. PMID: 37843848; PMCID: PMC10580151.

Betz ME, Fowler NR, Meza K, Bletz A, Omeragic F, Matlock DD. "You just have to be careful how you do it": A qualitative study of the Healthwise decision aid for older drivers. Traffic Inj Prev. 2024 Jun 11:1-7. doi: 10.1080/15389588.2024.2351203. Epub ahead of print. 
PMID: 38860882.

Liu D, Chihuri S, Andrews HF, Betz ME, DiGuiseppi C, Eby DW, Hill LL, Jones V, Mielenz TJ, Molnar LJ, Strogatz D, Lang BH, Li G. Diabetes mellitus and hard braking events in older adult drivers. Inj Epidemiol. 2024 Jun 5;11(1):22. doi: 10.1186/s40621-024-00508-2. PMCID: PMC11151638. 
PMID: 38840227.

Jian Q, Chihuri S, Andrews HF, Betz ME, DiGuiseppi C, Eby DW, Hill LL, Jones V, Mielenz TJ, Molnar LJ, Strogatz D, Lang BH, Li G. Association between polypharmacy and hard braking events in older adult drivers. Accid Anal Prev. 2024 May 30;204:107661. doi: 10.1016/j.aap.2024.107661. Epub ahead of print. 
PMID: 38820927.

Walsh A, Ghahramanlou-Holloway M, Stanley IH, Betz ME, Heintz Morrissey B, Godin S, Morgenstein J, LaCroix J, Cobb E, Grammer J, Button CJ. Firearm leadership: Development, analysis, and application of a novel concept to message secure storage of firearms in the military. Mil Psychol. 2024 Apr 9:1-7. doi: 10.1080/08995605.2024.2336641. Epub ahead of print. 
PMID: 38592404

Isom CA, Baird S, Betz ME, DiGuiseppi CG, Eby DW, Li G, Lee KC, Molnar LJ, Moran R, Strogatz D, Hill L. Association of Depression and Antidepressant Use With Driving Behaviors in Older Adults: A LongROAD Study. J Appl Gerontol. 2024 Mar 13:7334648241238313. doi: 10.1177/07334648241238313. Epub ahead of print. 
PMID: 38477230

Stanley IH, Anestis MD, Bryan CJ, Moceri-Brooks J, Baker JC, Buck-Atkinson J, Bryan AO, Johnson M, Hunter K, Johnson RL, Xiao M, Betz ME. Project Safe Guard: Challenges and opportunities of a universal rollout of peer-delivered lethal means safety counseling at a US military installation. Suicide Life Threat Behav. 2024 Feb 21. doi: 10.1111/sltb.13050. Epub ahead of print. 
PMID: 38380441

Kennedy SR, Buck-Atkinson J, Moceri-Brooks J, Johnson ML, Anestis MD, Carrington M, Baker JC, Fisher ME, Nease DE Jr, Bryan AO, Bryan CJ, Betz ME. Military community engagement to prevent firearm-related violence: adaptation of project safe guard for service members. Inj Epidemiol. 2024 Feb 15;11(1):7. doi: 10.1186/s40621-024-00490-9. PMCID: PMC10867994. 
PMID: 38355727

Boggs JM, Quintana LM, Beck A, Clarke CL, Richardson L, Conley A, Buckingham ET, Richards JE, Betz ME. A Randomized Control Trial of a Digital Health Tool for Safer Firearm and Medication Storage for Patients with Suicide Risk. Prev Sci. 2024 Jan 11. doi: 10.1007/s11121-024-01641-6. Epub ahead of print. 
PMID: 38206548

2023

DiGuiseppi CG, Johnson RL, Betz ME, Hill LL, Eby DW, Jones VC, Mielenz TJ, Molnar LJ, Strogatz D, Li G. Migraine headaches are associated with motor vehicle crashes and driving habits among older drivers: Prospective cohort study. J Am Geriatr Soc. 2023 Dec 22. doi: 10.1111/jgs.18719. Epub ahead of print. PMID: 38133994

Betz ME, Meza K, Friedman K, Moceri-Brooks J, Johnson ML, Simonetti J, Baker JC, Bryan CJ, Anestis MD. 'Whether it's your weapon or not, it's your home': US military spouse perspectives on personal firearm storage. BMJ Mil Health. 2023 Dec 22:e002591. doi: 10.1136/military-2023-002591. Epub ahead of print. PMID: 38135459

Fowler NR, Johnson RL, Peterson R, Schroeder MW, Omeragic F, DiGuiseppi C, Han SD, Hill L, Betz ME. Relationship of Decisional Conflict About Driving Habits Between Older Adult Drivers and Their Family Members and Close Friends. J Appl Gerontol. 2023 Dec 12:7334648231211742. doi: 10.1177/07334648231211742. Epub ahead of print. PMID: 38087851

Villarreal RI, Stanley IH, Anestis MD, Buck-Atkinson J, Betz ME. Older Adults' Preferences Regarding Firearm Locking Device Use: Results of a National Survey. Clin Gerontol. 2023 Nov 23:1-11. doi: 10.1080/07317115.2023.2285994. Epub ahead of print. PMID: 37994864

Betz ME, Bowen DM, Rowhani-Rahbar A, McCourt AD, Rivara FP. State Reporting Requirements for Involuntary Holds, Court-Ordered Guardianship, and the US National Firearm Background Check System. JAMA Health Forum. 2023 Nov 3;4(11):e233945. doi: 10.1001/jamahealthforum.2023.3945. PMCID: PMC10656649. PMID: 37976049

Liu Y, Chihuri S, Mielenz TJ, Andrews HF, Betz ME, DiGuiseppi C, Eby DW, Hill LL, Jones V, Molnar LJ, Strogatz D, Li G. Motor Vehicle Crash Risk in Older Adult Drivers With Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open. 2023 Oct 2;6(10):e2336960. doi: 10.1001/jamanetworkopen.2023.36960. PMCID: PMC10551766. PMID: 37792374

Betz ME, Frattaroli S, Knoepke CE, Johnson R, Christy A, Schleimer JP, Pear VA, McCarthy M, Kapoor R, Norko MA, Rowhani-Rahbar A, Ma W, Wintemute GJ, Swanson JW, Zeoli AM. Extreme Risk Protection Orders in Older Adults in Six U.S. States: A Descriptive Study. Clin Gerontol. 2023 Sep 9:1-8. doi: 10.1080/07317115.2023.2254279. Epub ahead of print. PMID: 37688772

Liang Z, Chihuri S, Andrews HF, Betz ME, DiGuiseppi C, Eby DW, Hill LL, Jones V, Mielenz TJ, Molnar LJ, Strogatz D, Li G. Interaction between benzodiazepines and prescription opioids on incidence of hard braking events in older drivers. J Am Geriatr Soc. 2023 Aug 11. doi: 10.1111/jgs.18544. Epub ahead of print. PMID: 37566203

Barnard LM, Wright-Kelly E, Brooks-Russell A, Betz ME. Characterization of Mass Shootings by State, 2014-2022. JAMA Netw Open. 2023 Jul 3;6(7):e2325868. doi: 10.1001/jamanetworkopen.2023.25868. PMCID: PMC10372703. PMID: 37494046

Barnard LM, Knoepke CE, McCarthy M, Rowhani-Rahbar A, Siry-Bove BJ, Betz ME. Views of voluntary, temporary out-of-home firearm storage among individuals living in a firearm-owning home: results from a qualitative study in two states. Inj Prev. 2023 Jul 14:ip-2023-044868. doi: 10.1136/ip-2023-044868. Epub ahead of print. PMID: 37451860

Fenton L, Han SD, DiGuiseppi CG, Fowler NR, Hill L, Johnson RL, Peterson RA, Knoepke CE, Matlock DD, Moran R, Karlawish J, Betz ME. Mild Cognitive Impairment Is Associated with Poorer Everyday Decision Making. J Alzheimers Dis. 2023 Jul 12. doi: 10.3233/JAD-230222. Epub ahead of print. PMID: 37458034

Buck-Atkinson J, McCarthy M, Stanley IH, Harnke B, Anestis MD, Bryan CJ, Baker JC, Betz ME. Firearm locking device preferences among firearm owners in the USA: a systematic review. Inj Epidemiol. 2023 Jul 6;10(1):33. doi: 10.1186/s40621-023-00436-7. PMCID: PMC10326943. PMID: 37415242

Trinka T, Oesterle DW, Silverman AC, Vriniotis MG, Orchowski LM, Beidas RS, Betz ME, Hudson C, Kesner T, Ranney ML. Bystander intervention to prevent firearm injury: A qualitative study of 4-H shooting sports participants. J Community Psychol. 2023 Jun 9. doi: 10.1002/jcop.23069. Epub ahead of print. PMID: 37294273

Stanley IH, Lebeaut A, Betz ME, Wright A, Vujanovic AA. Firearm ownership and storage practices among United States firefighters and emergency medical services personnel. Psychol Serv. 2023 Jun 1. doi: 10.1037/ser0000780. Epub ahead of print. PMID: 37261761

Haasz M, Sigel E, Betz ME, Leonard J, Brooks-Russell A, Ambroggio L. Acceptability of Long versus Short Firearm Safety Education Videos in the Emergency Department: A Pilot Randomized Controlled Trial. Ann Emerg Med. 2023 May 2:S0196-0644(23)00215-9. doi: 10.1016/j.annemergmed.2023.03.023. Epub ahead of print. PMID: 37140494

Davis S, Betz ME, Hill LL, Eby DW, Jones VC, Mielenz TJ, Molnar LJ, Strogatz D, Clancy K, Li G, DiGuiseppi CG. Associations of cannabis use with motor vehicle crashes and traffic stops among older drivers: AAA LongROAD study. Traffic Inj Prev. 2023 Mar 20:1-8. doi: 10.1080/15389588.2023.2180736. Epub ahead of print. PMID: 36939676

Barnard LM, Johnson RL, Brandspigel S, Rooney LA, McCarthy M, Rivara FP, Rowhani-Rahbar A, Knoepke CE, Peterson RA, Betz ME. Practices, knowledge, and concerns for out-of-home firearm storage among those with access to firearms: results from a survey in two states. Inj Epidemiol. 2023 Mar 13;10(1):15. doi: 10.1186/s40621-023-00426-9. PMCID: PMC10012481. PMID: 36915179

Betz ME, Barnard LM, Knoepke CE, Rivara FP, Rowhani-Rahbar A. Creation of online maps for voluntary out-of-home firearm storage: Experiences and opportunities. Prev Med Rep. 2023 Feb 25;32:102167. doi: 10.1016/j.pmedr.2023.102167. PMCID: PMC9986617. PMID: 36891542

Anestis MD, Moceri-Brooks J, Johnson RL, Bryan CJ, Stanley IH, Buck-Atkinson JT, Baker JC, Betz ME. Assessment of Firearm Storage Practices in the US, 2022. JAMA Netw Open. 2023 Mar 1;6(3):e231447. doi: 10.1001/jamanetworkopen.2023.1447. PMCID: PMC9982690. PMID: 36862408

Betz ME, Simonetti JA. Approaches to Prevention of Firearm Violence-Reply. JAMA. 2023 Feb 14;329(6):513-514. doi: 10.1001/jama.2022.21865. PMID: 36786794

Betz ME, Stanley IH, Buck-Atkinson J, Johnson R, Bryan CJ, Baker JC, Bryan AO, Hunter K, Anestis MD. Firearm Owners' Preferences for Locking Devices: Results of a National Survey. Ann Intern Med. 2023 Feb 7. doi: 10.7326/M22-3113. Epub ahead of print. PMID: 36745884

McCarthy V, Portz J, Fischer SM, Greenway E, Johnson RL, Knoepke CE, Matlock DD, Omeragic F, Peterson RA, Ranney ML, Betz ME. A Web-Based Decision Aid for Caregivers of Persons With Dementia With Firearm Access (Safe at Home Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2023 Jan 31;12:e43702. doi: 10.2196/43702. PMID: 36719721

Media

Resilience Round Up Podcast: Securing Hope: Strategies for Lethal Means Safety

This episode's guest is Dr. Emmy Betz who is an emergency physician and nationally recognized leader in firearm injury prevention and suicide prevention. She is currently a professor of emergency medicine at the University of Colorado School of Medicine, where she is the founding director of the Firearm Injury Prevention Initiative.

The topic is Securing Hope: Strategies for Lethal Means Safety. Dr. Betz dives into an in-depth discussion on Lethal Means Safety (LMS), including how Army personnel can integrate LMS into their roles as a means of reducing harmful behaviors and preventing suicide. Along with explaining how LMS is carried out within the Defense Department and addressed in the Army's Strategic Plan, Dr. Betz addresses misconceptions about suicide and LMS, provides the latest research updates and recommends evidence-based activities that listeners can adopt. Listen to the podcast Securing Hope: Strategies for Lethal Means Safety